| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| 92014 |
Ophthalmological services: medical examination and evaluation, comprehensive, established patient |
133 |
133 |
$7K |
| 92004 |
Ophthalmological services: medical examination and evaluation, comprehensive, new patient |
112 |
112 |
$5K |
| 92015 |
Determination of refractive state |
466 |
466 |
$2K |
| V2020 |
Frames, purchases |
99 |
99 |
$2K |
| 92340 |
Fitting of spectacles, except for aphakia; monofocal |
82 |
82 |
$2K |
| V2100 |
Sphere, single vision, plano to plus or minus 4.00, per lens |
69 |
69 |
$1K |
| V2784 |
Lens, polycarbonate or equal, any index, per lens |
50 |
50 |
$912.00 |